Morphofunctional characteristics of the vessels of the small circle of blood circulation in those who died from severe and extremely severe forms of new coronavirus infection

Aleksey M. Emelin; Емелин Алексей Михайлович; Irina Sorochanu; Сорочану Ирина; Zakhar P. Asaulenko; Асауленко Захар Павлович; Vasilii А. Rogovoi; Роговой Василий Андреевич; Oleg S. Popov; Попов Олег Сергеевич; Sergei V. Mosenko; Мосенко Сергей Викторович; Svetlana V. Apalko; Апалько Светлана Вячеславовна; Anton S. Buchaka; Бучака Антон Сергеевич; Sergey V. Gladchenko; Гладченко Сергей Викторович; Anna Yu. Anisenkova; Анисенкова Анна Юрьевна; Sergey G. Shcherbak; Щербак Сергей Григорьевич; Roman V. Deev; Деев Роман Вадимович

doi:10.17816/morph.625835

Morphofunctional characteristics of the vessels of the small circle of blood circulation in those who died from severe and extremely severe forms of new coronavirus infection

Authors: Emelin A.M.¹, Sorochanu I.¹, Asaulenko Z.P.¹^,2, Rogovoi V.А.¹, Popov O.S.², Mosenko S.V.², Apalko S.V.², Buchaka A.S.², Gladchenko S.V.², Anisenkova A.Y.³^,2, Shcherbak S.G.³^,2, Deev R.V.⁴^,2
Affiliations:
1. North-Western State Medical University named after I.I. Mechnikov
2. City Hospital N 40 Recreation Administrative District of St. Petersburg
3. Saint Petersburg State University
4. Avtsyn research institute of human morphology of federal state budgetary scientific institution "Petrovsky national research centre of surgery"
Section: Original Study Articles
URL: https://j-morphology.com/1026-3543/article/view/625835
DOI: https://doi.org/10.17816/morph.625835
ID: 625835

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Abstract
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Abstract

BACKGROUND: An important feature of COVID-19 is the development of pronounced hypercoagulation with an increased risk of thrombotic damage to the pulmonary vascular bed, mainly the pulmonary arteries. Thrombosis of the pulmonary blood vessels causes a local violation of hemodynamics with the development of hyperemia, edema, which leads to a decrease in ventilation of the lung tissue area and serves as one of the causes of respiratory failure.

AIM: This study aimed to conduct a morphological and morphometric analysis of the vascular bed of lung tissues in deceased with severe and extremely severe forms of new coronavirus infection who were on inpatient treatment in the period 2020-2022.

METHODS: A pathomorphologic study of 129 autopsy cases with a confirmed diagnosis of a new coronavirus infection COVID-19 was performed. Morphometric analysis and statistical data processing of the pulmonary vascular system in histologic preparations stained with hematoxylin and eosin stain, orcein stain and Martius Scarlet Blue (MSB) stain was performed. The control group consisted of 14 patients who died of cardiovascular disease with bilateral focal confluent pneumonia.

RESULTS: It was found that the proportion of thrombosed vessels in the lung tissues of the deceased was 27.6%. In 87.2% of cases, thrombosis develops in small arteries (lumen diameter 30-500 microns) and small veins (lumen diameter 40-500 microns). The vascular-functional indices of Kernogan and Vogenworth were statistically significantly increased in small arteries and small veins of the 4th order (p=0.001), small arteries (p=0.001) and small veins of the 5th order (p=0.014) compared with the control group.

CONCLUSION: Diffuse involvement of small caliber blood vessels in the pathological process reflects the severity of specific hemocoagulopathic disorders in the lung tissue. Such disorders lead to the development of ventilation-perfusion disorders and entail an increase in right ventricular failure.

Keywords

COVID-19, thrombosis, embolism, pulmonary circulation.

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Table 1. Vital signs of patients who died from a new coronavirus infection on the first and last days of hospitalization. N - number of analyzed observations

Table 2. Data from clinical, biochemical blood tests and coagulograms in patients who died from a new coronavirus infection on the first and last days of hospitalization

Table 3. The proportion of thrombosed blood vessels of the lungs depending on the order according to S. Singhal et al. (1973)

Table 4. The proportion of thrombosed blood vessels in the lungs depending on the internal diameter according to N. C. Staub and E. L. Schultz (1968)

Table 5. The proportion of the age of blood clots in the blood vessels of the small circle of circulation in those who died from a new coronavirus infection

Table 6. Comparison of the Kernogan index depending on their order and inner diameter. Only data with significant differences p≤0.05 are given

Table 7. Comparison of the Vogenworth index depending on their order and inner diameter. Only data with significant differences p≤0.05 are given

ADDITIONAL INFORMATION

Funding source. The study was carried out within the framework of the project of St. Petersburg State University ID 94029859.

Competing interests. The authors declare the absence of obvious and potential conflicts of interest related to the publication of this article.

Authors’ contribution. All authors confirm that their authorship meets the international ICMJE criteria (all authors have made a significant contribution to the development of the concept, research and preparation of the article, read and approved the final version before publication). A.M. Emelin – collection and processing of material, writing the text; I. Sorochanu – literature review, collection and processing of material, writing the text; Z.P. Asaulenko – literature review, collection and processing of material, writing the text; V.A. Rogovoy - collection and processing of material, writing the text; O.S. Popov - concept and design research, collection and processing of material; S.V. Mosenko – concept and design research, collection and processing of material; S.V. Apalko – concept and design of research, collection and processing of material; A.S. Buchaka – collection and processing of material; S.V. Gladchenko – concept and design of research; A.Yu. Anisenkova - concept and design of research; S.G. Shcherbak - the concept and design of the study; R.V. Deev - the concept and design of the study, writing and editing the text.

About the authors

Aleksey M. Emelin

North-Western State Medical University named after I.I. Mechnikov

Email: eamar40rn@gmail.com
ORCID iD: 0000-0003-4109-0105
SPIN-code: 5605-1140

Assistant of the Department of Pathological Anatomy

Russian Federation, 41, Kirochnaya str., Saint Petersburg, Russia, 191015

Irina Sorochanu

North-Western State Medical University named after I.I. Mechnikov

Author for correspondence.
Email: opeairina@gmail.com
ORCID iD: 0000-0002-6909-8937
SPIN-code: 4072-3845
Scopus Author ID: 57817025400

Student

Russian Federation, 41, Kirochnaya str., Saint Petersburg, Russia, 191015

Zakhar P. Asaulenko

North-Western State Medical University named after I.I. Mechnikov; City Hospital N 40 Recreation Administrative District of St. Petersburg

Email: zakhariy@list.ru
ORCID iD: 0000-0001-7062-065X
SPIN-code: 7382-2036

Assistant of the Department of Pathological Anatomy; Pathologist of the Pathology Department

Russian Federation, 41, Kirochnaya str., Saint Petersburg, Russia, 191015; 9, Borisova str., Sestroretsk, Saint Petersburg, Russia, 197706

Vasilii А. Rogovoi

North-Western State Medical University named after I.I. Mechnikov

Email: rogovoy-vasiliy@mail.ru
ORCID iD: 0009-0009-9192-7592
SPIN-code: 5734-1322

Student

Russian Federation, 41, Kirochnaya str., Saint Petersburg, Russia, 191015